血清指标对骨肉瘤化疗预后判别价值

Predictive value of serum parameters for prognosis of osteosarcoma after chemotherapy

[目的]分析血清碱性磷酸酶(ALP)、肿瘤特异性生长因子(TSGF)对骨肉瘤化疗后预后的预测价值。[方法]2013年1月~2015年1月,110例骨肉瘤患者,均经新辅助化疗及手术治疗。其中100例患者5年以上随访资料完整,按临床结果将患者分为预后良好组和预后不良组。比较两组血清ALP、TSGF水平及其他资料。采用逻辑回归分析法分析骨肉瘤化疗后预后影响因素。绘制受试者工作曲线(ROC),分析血清ALP、TSGF对骨肉瘤化疗后预后的预测价值。[结果]与良好组比较,不良组Enneking分期高比率大,远处转移比率高,血清ALP、TSGF水平均升高(P<0.05)。逻辑回归分析显示,Enneking分期高(OR=1.931,P=0.002)、有远处转移(OR=1.998,P=0.004)、血清ALP升高(OR=5.485,P<0.001)、血清TSGF升高(OR=4.289,P<0.001)是骨肉瘤化疗后预后不良的危险因素。ROC分析显示,血清ALP、TSGF预测骨肉瘤化疗后预后不良的最佳截断点分别为325.87 U/L、75.64 U/ml。血清ALP、TSGF单独及联合预测骨肉瘤化疗后预后不良的AUC分别为0.725、0.716、0.798。[结论]血清ALP、TSGF联合检测对骨肉瘤化疗后预后预测价值较高,可为临床该病治疗提供参考。

[Objective]To evaluate the predictive value of serum alkaline phosphatase(ALP)and tumor supplied group of factors(TSGF)for prognosis of osteosarcoma after chemotherapy.[Methods]From January 2015 to January 2017,110 patients received neoadjuvant chemotherapy and surgery for osteosarcoma in our hospital.Of them,100 patients who were followed up for more than 5 years were divided into good and poor prognosis groups based on the clinical consequences.The serum ALP,TSGF levels and other data were compared between the two groups.Logistic regression analysis was used to analyze the prognostic factors of osteosarcoma after chemotherapy.The receiver operating curve(ROC)was drawn to analyze the predictive value of serum ALP and TSGF on the prognosis of osteosarcoma after chemotherapy.[Results]The poor group had significantly higher ratio of advancing Enneking stage,significantly higher ratio of distant metastasis,significantly higher levels of serum ALP and TSGF than the good group(P<0.05).As results of Logistic regression analysis,the advancing Enneking stage(OR=1.931,P=0.002),distant metastasis(OR=1.998,P=0.004),increasing serum ALP(OR=5.485,P<0.001),and serum TSGF(OR=4.289,P<0.001)were risk factors related to poor prognosis of osteosarcoma after chemotherapy.In term of ROC,the best cutoff points for serum ALP and TSGF to predict poor prognosis after chemotherapy of osteosarcoma were 325.87 U/L and 75.64 U/mL respectively.The AUC of serum ALP and TSGF alone and their combination to predict the poor prognosis of osteosarcoma after chemotherapy were 0.725,0.716 and 0.798 respectively.[Conclusion]The combination of serum ALP and TSGF has a high predictive value for the prognosis of osteosarcoma after chemotherapy,and might provide a reference for clinical treatment of this disease.